改良Bilhaut-Cloquet术治疗WasselⅠ型和Ⅱ型复拇畸形的临床效果分析

Clinical Application Effect of Modifi ed Bilhaut-Cloquet Surgery in the Treatment of Wassel TypeⅠand Type Ⅱ Compound Thumb Deformity

目的:探讨改良Bilhaut-Cloquet术治疗WasselⅠ型和Ⅱ型复拇畸形的临床效果。方法:选取90例WasselⅠ型和Ⅱ型复拇畸形患儿为研究对象,其中对照组43例(传统Bilhaut-Cloquet术),实验组47例(改良Bilhaut-Cloquet术)。术后随访6个月~2年,比较两组术后指关节功能、疗效、拇指外观及满意度。结果:术后,实验组指关节运动范围、关节稳定性优于对照组,成角畸形评分优于对照组,差异有统计学意义(P<0.05)。两组优良率比较差异无统计学意义(P>0.05)。术后,实验组拇指窄小发生率高于对照组,对照组拇指宽大及指甲畸形发生率高于实验组,差异有统计学意义(P<0.05)。实验组温哥华瘢痕量表(Vancouverscarscale,VSS)评分优于对照组,且实验组患儿/家属总满意度高于对照组(93.62%vs76.74%),差异有统计学意义(P<0.05)。结论:改良Bilhaut-Cloquet术治疗WasselⅠ型和Ⅱ型复拇畸形效果好,关节稳定度、活动度等改善程度皆优于传统术式,术后患儿/家属满意度较高,值得推广应用。

Objective To investigate the clinical application effect of modified Bilhaut-Cloquet surgery in the treatment of Wassel type Ⅰ and type Ⅱ compound thumb deformity. Methods 90 patients with Wassel type type Ⅰ and type Ⅱ compound thumb deformity were selected, including 43 cases in the control group(traditional Bilhaut-Cloquet surgery) and 47 cases in the experimental group(modifi ed Bilhaut-Cloquet surgery). The patients were followed up for 6 months to 2 years after surgery, the postoperative fi nger joint function, curative ef fect, thumb appearance and satisfaction were compared between the two groups.Results After surgery, the range of motion of fi nger joint and joint stability of the experimental group were better than those of the control group, and the angulation deformity was better than that of the control group, the dif ferences were statistically significant(P<0.05). There was no significant difference in the excellent rate between the two groups(P>0.05).After operation, the incidence of thumb narrowing in the experimental group was higher than that in the control group, and the incidence of thumb widening and nail deformity in the control group was higher than those in the experimental group(P<0.05). The VSS score of the experimental group was better than that of the control group(P<0.05).The total satisfaction of the children/family members of the experimental group was higher than that of the control group(93.62%vs 76.74%, P<0.05).Conclusion The modifi ed Bilhaut-Cloquet surgery has a good ef fect in the treatment of Wassel type Ⅰ and type Ⅱ compound thumb deformity. The improvement of joint stability and mobility is better than that of the traditional surgery.The satisfaction of children/family members after the operation is high, which is worth popularizing.